What does this denial code mean?

EVV data requirements not fulfilled

The claim was processed against Electronic Visit Verification requirements and the required EVV data was not there — the payer found no fulfilled EVV record backing the service. This is the general-purpose EVV remark payers use when the visit-data requirement itself failed.

EVV data not submitted through the state EVV system

The payer expected this service's visit data to arrive through the state-designated EVV vendor or aggregator, and it didn't. Either the visit was never exported from your EVV system, or it was captured outside the approved vendor path (for example, an alternate EVV system that isn't certified with the aggregator).

Recipient not found in the EVV system

The person you billed for does not exist in your EVV account as far as the payer can tell. In Ohio's published guide this fires when the Recipient Medicaid ID on the claim isn't in your Sandata account — either the client was never added, or the ID on the visit is wrong (an 'Unknown Recipient' visit also lands here).

Billed units exceed the verified EVV visit

A verified EVV visit exists and matches the claim — but the units on the claim line are more than the visit supports. The clock-in/clock-out span verified fewer units than you billed. Everything else matched; the time didn't.

Provider ID not matched in the EVV system

On its own, N521 is a generic provider-information mismatch — it is not an EVV code everywhere. But in Ohio Medicaid remittances, ODM's own error guide publishes CARC 272 + N521 as the EVV 'Provider ID does not match' error: the Provider Medicaid ID on the claim is not in Sandata, either because you haven't registered a Sandata account or because your Sandata account uses a different Medicaid ID than the one you bill under.

No matching verified EVV visit for the service billed

On its own, N56 is a generic wrong-procedure-code remark — not an EVV code everywhere. In Ohio Medicaid remittances, ODM's error guide publishes CARC 272 + N56 as the EVV 'Procedure Code does not match' error: there is no visit in your EVV account that matches this provider, recipient, and service — the visit doesn't exist, isn't in Verified status yet, or was recorded under a different payer or service.

EVV enforcement warning (soft launch)

N363 is a generic 'rules are about to change' alert — not an EVV code by itself. But during EVV soft launches, payers use it to warn that this exact claim WOULD have denied under EVV matching: Ohio MyCare plans print it in place of the EVV denial codes before their enforcement dates, and Missouri put it on remittances during the January 2026 soft launch before hard denials began April 1, 2026. The claim paid this time; the same claim won't once enforcement starts.

PA ESC 925 — EVV visit verified (informational)

Good news, not a denial: ESC 925 means Pennsylvania found a matching, verified EVV visit for this personal-care claim line. Its home-health twin is ESC 935. You'll see these codes on lines that passed EVV matching.

PA ESC 926 — duplicate EVV visits

Pennsylvania found more than one EVV visit record matching this claim line, so it can't tell which one backs the service — and it denies rather than guessing. Its home-health twin is ESC 936. Common causes: visit files sent twice, and multi-worker overlap situations.

PA ESC 927 — billed units exceed verified units

A verified visit exists, but the claim bills more units than the visit's verified time supports. Pennsylvania does not automatically cut the claim back to the verified units — it denies the whole line. Home-health twin: ESC 937.

PA ESC 928 — no matching EVV visit

Pennsylvania's most important EVV denial: no visit record matched this claim line. DHS's published causes: no visit was sent; the visit arrived after the claim; the visit is stuck in Incomplete status; or a field mismatch on date of service, recipient ID, procedure code, or provider MPI. The trap DHS itself calls out as frequently seen: billing with the 9-digit MA ID where the 10-digit recipient RID is required. Home-health twin: ESC 938.

PA ESC 933 — claim line format error

The claim line itself is shaped wrong for EVV matching — most often because a single line spans 31 days or more, which Pennsylvania's matcher won't process.

PA ESC 938 — no matching EVV visit (home health)

The home-health twin of ESC 928: no EVV visit record matched this home-health claim line. Same published causes — visit never sent, visit arrived after the claim, visit stuck Incomplete, or a mismatch on date of service, recipient RID, procedure code, or provider MPI. The 9-digit-MA-ID-instead-of-10-digit-RID trap applies here too.